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A professor of medicine at Harvard Medical School and a primary care physician at Boston's Beth Israel Deaconess Medical Center, he also served as senior consultant for this program.

From the words flying back and forth, The Vaccine War has got more than a few people riled up. Infections, tragedies, and public health debates rarely lack controversy. But recall also that a few months ago the world was in uproar about Swine Flu. How bad would it be? How widespread? Would the vaccines work? When would they arrive? Who should get first crack at them ... the elderly, the young, pregnant women, health workers? Everyone was on edge, including us, the primary care doctors who'd help deliver the goods once they arrived.

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A professor of medicine at Harvard Medical School and a primary care physician at Boston's Beth Israel Deaconess Medical Center, he also served as senior consultant for this program.

Assuming a) that you have now watched The Vaccine War, that b) some of you have been watching or took part in the discussion/debate/arguments that have marked this Forum for the past several days, or c) that you are looking into this for the first time, let us welcome you (back)!

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A pediatrician in Boston and co-author of Quirky Kids: Understanding and Helping Your Child Who Doesn't Fit In. She recently completed an autism fellowship at Boston Medical Center and is the mother of three children.

Because there have been many posts relating stories about children who regressed after receiving their vaccines, I would like to address what the community of clinical autism specialists have come to believe, based on many years of observation and analysis of children on the spectrum. Autism is largely believed to be a biologically based neurodevelopmental disorder, which in most cases means a child will or will not develop autistic features based on their biology at birth and their genetic heritage. A developmental regression is a very alarming thing to see. Pediatric residents are taught to ask about it and look for it in very young children because it often

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An assistant professor of medicine at Harvard Medical School and a member of the Division of Infectious Diseases, Beth Israel Deaconess Medical Center. She is the director of the BIDMC travel medicine clinic and the mother of two young children.

A few months ago I got an email from my cousin. "Should I really be giving my baby all these vaccines at once?" Spacing vaccines is now a hot topic among young mothers. Why do them all at once when you can spread them out over several visits? Curious, I raised the question with my own pediatrician. "I can do that if you want, "she said, "but I feel bad for my relationship with the child." How can they grow to trust their doctor if every visit comes with a needle? And they learn fast. With just a handful of words under her belt, my daughter mustered up "Oh-oh!" as soon as we checked in for her 12 month visit. So then I researched the issue and discovered something surprising:

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A pediatrician in Boston and co-author of Quirky Kids: Understanding and Helping Your Child Who Doesn't Fit In. She recently completed an autism fellowship at Boston Medical Center and is the mother of three children.

Kim Spencer comments in her post that infants do not need Hepatitis B vaccine because the only way that one can contract the virus is through needle sharing and sexual intercourse. In fact, in fully one third of cases of Hepatitis B, the exposure is completely unknown. Exchange of blood or semen is not required to transmit Hepatitis B. The reason to vaccinate as early as possible is because the earlier a child contracts Hepatitis B

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COMMENTS (34)

A pediatrician in Boston and co-author of Quirky Kids: Understanding and Helping Your Child Who Doesn't Fit In. She recently completed an autism fellowship at Boston Medical Center and is the mother of three children.

Some parents have asked how we help them think about the wildly different information they hear about vaccines, and how they are supposed to make an informed decision about what is best for their baby or toddler. This is a common occurrence in our pediatric practice. Most parents come to their first visit to the pediatrician armed with questions. The majority have done their research on the Internet, and anyone who has googled "vaccines" or "vaccines and autism" knows it's overwhelming and very frightening to new parents of young babies. We recognize that anxiety...

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COMMENTS (16)

An assistant professor of medicine at Harvard Medical School and a member of the Division of Infectious Diseases, Beth Israel Deaconess Medical Center. She is the director of the BIDMC travel medicine clinic and the mother of two young children.

Sara Powell asks why researchers used the Hepatitis A vaccine for the control group instead of just placebo in the JAMA study I recently blogged here about. Great question, Sara. The methods section states that hepatitis A vaccine was chosen for the control group "because it is well tolerated and provides a potential health benefit given reported outbreaks of Hepatitis A on Hutterite colonies" (the communities studied). Since studies have to be approved by the...

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A professor of medicine at Harvard Medical School and a primary care physician at Boston's Beth Israel Deaconess Medical Center, he also served as senior consultant for this program.

When you're nervous about vaccines -- and many of the diseases they target have disappeared from sight or certainly don't seem nearby -- it's easy to understand hesitancy about piercing a baby's skin again and again. When I discuss the relatively new vaccine against shingles with my aging patients, it's simpler. Among those "of a certain age," almost everyone has seen shingles, and many know friends or acquaintances knocked for a loop by that virus, with more than a few left with ugly scars or chronic pain. So it's much easier for my patients to consider the risks vs benefits because they have some firsthand knowledge of the risks...

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COMMENTS (25)

A professor of medicine at Harvard Medical School and a primary care physician at Boston's Beth Israel Deaconess Medical Center, he also served as senior consultant for this program.

From the first days of medical school, we're taught to stay away from anecdote. "When you see a patient with symptom x, consider the possibilities carefully, but you'd best ignore what the last patient with the same symptom turned out to have. If you assume this is the same illness, time and again you'll find yourself misled by anecdote." But fervent beliefs growing out of a singular experience seem to be spreading. Today, more and more people are convinced that Diet A, Pill B, Activity C, or Potion D has transformed their lives...

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COMMENTS (16)

A pediatrician in Boston and co-author of Quirky Kids: Understanding and Helping Your Child Who Doesn't Fit In. She recently completed an autism fellowship at Boston Medical Center and is the mother of three children.

Many posts have included references to the increased prevalence of autism. There are several aspects to the autistic disorders that make this question especially interesting. First, the autism "spectrum" refers to children with a wide range of ability and disability, and this is quite new. If we compare the current estimates with those of even 20 years ago...

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An assistant professor of medicine at Harvard Medical School and a member of the Division of Infectious Diseases, Beth Israel Deaconess Medical Center. She is the director of the BIDMC travel medicine clinic and the mother of two young children.

Thanks for the contributions, here are a few responses: TJ Kline questions the efficacy of vaccines since many of the persons affected by the current mumps outbreak in New York and New Jersey were already vaccinated. That's true, TJ, and an unfortunate reality in vaccine medicine: despite ongoing efforts, vaccines aren't 100% effective. This is particularly true for mumps vaccine, which has a more variable efficacy rate in the literature. Compare that to recent ...

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COMMENTS (12)

A professor of medicine at Harvard Medical School and a primary care physician at Boston's Beth Israel Deaconess Medical Center, he also served as senior consultant for this program.

Several respondents comment here about the (apparent) increase in the prevalence of autism. Two questions about it, and the film addresses both: 1) Is it real? 2) If it is, why is it happening? I'll offer a few observations on the first question here....Suffice to say that measuring prevalence (how many people have condition x at a given point in time) has never been easy, and there have been some real goofs along the line. For example, acute rheumatic fever (ARF)..

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COMMENTS (20)

A pediatrician in Boston and co-author of Quirky Kids: Understanding and Helping Your Child Who Doesn't Fit In. She recently completed an autism fellowship at Boston Medical Center and is the mother of three children.

As a pediatric resident in Boston in the 1980's, I spent a lot of time caring for babies and young children with critical infectious diseases that we no longer see. Two bacterial organisms were especially common, household words among pediatricians: Haemophilus influenza type B (HIB) and Strep pneumonia (Pneumococcus). Both could cause infections in the blood, meningitis, pneumonia, bone infections, and abscesses in the brain and other organs. If the children were lucky enough to live close to the hospital and come in early in the course of their illness...

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An assistant professor of medicine at Harvard Medical School and a member of the Division of Infectious Diseases, Beth Israel Deaconess Medical Center. She is the director of the BIDMC travel medicine clinic and the mother of two young children.

Asked in a survey whether they thought vaccine decisions should be made by parents or government, focus group participants told political scientist Hank Jenkins-Smith they wanted to make their own decisions. Even those who agreed with vaccines wanted to be in charge. I'm not surprised. When it comes to my kids, I want to vote with my own feet too. And I do that with school choices, TV rules, video games, etc. But when you say "No" to vaccines for you, you are also saying "No," to some degree, for me. We've long known that children in the same community belong to a shared pool of infection risk. If I pay insurance but you don't, both of our kids are at increased risk.

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COMMENTS (38)

A professor of medicine at Harvard Medical School and a primary care physician at Boston's Beth Israel Deaconess Medical Center, he also served as senior consultant for this program.

Fear rules three memories of infections and efforts to avoid them in my childhood. My first experience with prevention taught me how to faint gracefully. As a child in England in the 1940s, we would get periodic Schick Tests, an injection testing whether we had antibodies against a dread disease, diphtheria. For some reason, I'd faint right after the needle was withdrawn, but I quickly learned to take it sitting down. Next, F.D.R was the family hero; he had helped save us Jews, and after arriving in America in 1948 a few years after the War, my parents quickly took my brother and me to pay respects at Hyde Park, the Roosevelt family home.

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